Clinical orders are requests placed by clinical or healthcare providers for, e.g., procedures, medications, laboratory tests, evaluations, treatments, and nursing tasks to be done for a patient. In a non-electronic clinical order system, clinical orders from different categories in one healthcare plan (such as medications, labs, diagnostic tests, and nursing orders) are generally documented on a single piece of paper. A healthcare plan includes multiple orders for treatment for a particular problem or ailment. For example, a healthcare plan for a cancer patient may include multiple medication orders and laboratory testing orders. Once these orders are reviewed by a healthcare provider, the necessary orders for different categories are forwarded to the correct location to be completed or filled. For example, if one order includes a medication, a medication paper order may be sent to the pharmacy to be filled. If one of the orders in the healthcare plan is for a laboratory test, a paper laboratory requisition form may be sent to the laboratory. In the paper healthcare ordering system, it is typically possible to go back to the original paper order set containing all of the orders for the healthcare plan. An example of a healthcare plan or procedure would be chemotherapy protocol that includes multiple orders for medications, laboratory tests, and diagnostic tests. Another example would be an arthroscopic surgical protocol that includes a pre-operative consultation, a surgical procedure, post-operative care, and physical therapy.
In an electronic healthcare order environment, if a set of orders is placed for a healthcare plan, once the orders have been reviewed, they are electronically dispersed to the appropriate location, such as the pharmacy or laboratory application. U.S. patent application Ser. Nos. 11/022,540, 11/020,489, and 11/021,509 (each of which is hereby incorporated by reference herein in its entirety) describe methods and systems for creating and maintaining associations among the orders in a healthcare plan in a computerized environment such that the associations may be accessed and viewed after one or more of the orders is distributed to the proper application to be filled.
Often times a clinical order (or set of clinical orders) will set forth a healthcare plan having components which span multiple phases. For instance, a healthcare plan for a chemotherapy protocol may specify that a particular medication is to be given in a specified dosage on three separate days, e.g., Day 1, Day 8, and Day 15. In this instance, each day may be viewed as a separate phase. Phases, however, are not limited to units of time. In simple terms, a phase is merely a plan and, accordingly, may be a unit of time, a diagnostic grouping, or any other sub-plan within a healthcare plan. In another example, a healthcare plan for an arthroscopic surgical protocol may specify that a pre-operative consultation, a surgical procedure, post-operative care, and physical therapy are to occur for a particular patient. In this instance, each of the pre-operative consultation, the surgical procedure, the post-operative care and the physical therapy are different phases of the clinical order for the arthroscopic surgical protocol.
Typically, in an electronic healthcare order environment, when a clinical order (or set of orders) spans multiple phases, each component of each phase appears to a user as a separate order. More importantly, each component of each phase appears to the electronic environment as a separate order. This means that each component of each phase must be entered into the electronic system separately and any modification to a particular component must be entered for that component in each of the phases in which it may appear. For instance, in the above chemotherapy protocol example, if it is desired to modify the dosage of the medication that is to be given to the patient on each of Days 1, 8 and 15, such modification must be separately entered for each of the three phases. Such duplicate entering is not only inefficient but increases the possibility of human error.
U.S. patent application Ser. Nos. 11/359,011, 11/359,012, and 11/359,013 (each of which is hereby incorporated by reference herein in its entirety) describe methods and systems for associating components which span multiple phases of a healthcare plan and permitting modification of components thereof to be applied to all components associated therewith. In this way, modifications may be entered one time instead of once for each phase to which they apply.
Utilizing a plan-based system such as that described in U.S. patent application Ser. Nos. 11/359,011, 11/359,012 and 11/359,013, healthcare plans spanning multiple phases may be ordered by a clinician or other healthcare provider as a unit. That is, a clinician or other healthcare provider may order a chemotherapy or arthroscopic surgery protocol for a particular patient, and each phase associated with the ordered protocol will be ordered. However, such multi-phase healthcare plans may only be ordered if the plan is capable of being performed at the same location or facility. For instance, it may be possible for a clinician to place an order for a chemotherapy protocol as it is likely that each phase of the chemotherapy protocol is going to be performed at the same location, e.g., the hospital or outpatient treatment facility. With respect to the arthroscopic surgery protocol, however, it is likely that some of the phases are not going to be performed at the same location. For instance, the surgical procedure and post-operative care are likely to be performed at a hospital while the physical therapy is likely to be performed at an outpatient physical therapy clinic. Thus, in the arthroscopic surgery protocol example, since all phases are not to be performed at the same location, ordering of the protocol as a single unit by placing a single clinical order is not possible.
Generally, the primary reason that a healthcare plan having multiple phases that are not all to be performed at the same location cannot be ordered by placing a single clinical order is because of the order catalog options made available to the ordering clinician or other healthcare provider. That is, when viewing the order catalog from which to select plans to be performed, the content of the order catalog that is made available to the ordering clinician includes only those plans which can be performed in association with a particular location—generally the location of the chart encounter (that is, the encounter the clinician or other healthcare provider has currently selected within the patient's chart). Thus, if a clinician is currently engaged with a chart encounter associated with a hospital, only plans that can be performed in their entirety at the hospital will be made available to the clinician for selection. In this way, not only are available plans limited to those plans which can be performed in their entirety at a single location, the single location at which they can be performed is the location of the chart encounter. Thus, healthcare plans that include multiple phases, wherein at least two of the phases are to be performed at differing locations with respect to one another, must be ordered as separate orders rather than as a single unit. Further, even plans having multiple phases, each of which is to be performed at the same location, cannot be ordered in association with a chart encounter as such plans will not be made available to the clinician or other healthcare provider for selection.